Lichen Planopilaris

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What is Lichen Planopilaris

Lichen planopilaris is one of the scarring alopecias and usually presents as patchy hair loss on the scalp. Lichen planopilaris encompasses various different forms of alopecia that lead to scarring including, central centrifugal cicatricial alopecia (CCCA), lichen planopilaris, cicatricial alopecia and frontal fibrosing alopecia.

What are the symptoms of Lichen planopilaris?

Lichen planopilaris usually presents as patchy hair loss on the scalp. The patches maybe red or inflamed and there may be scaling around the ndividual hair follicles. Patients may complain of burning pain or tenderness in these areas. The patches of hair loss may appear smooth and shiny due to the loss of the follicular openings.

Whilst the most common presentation is hair loss from the scalp, eyebrows and hair on the body can also be affected.

What causes Lichen planopilaris

The cause of lichen planopilaris is unknown but it is an inflammatory condition in the skin thought not to be associated with infection.

Who is at risk of Lichen planopilaris?

Lichen planopilaris is more common in women than in men. They mostly affect Caucasian females over the age of 40

How does a dermatologist diagnose Lichen planopilaris?

Early diagnosis is important to help halt the progression of the condition. There may be other hair loss conditions present and so a Dermatologist who specializes in hair loss and scalp conditions will look to identify all the conditions causing the hair loss.

Diagnosis may involve physical examination with a Dermatascope, hair pull tests, blood tests to rule out underlying medical conditions, and in some cases a scalp biopsy. A specialist pathologist who is experienced in hair loss and scalp conditions will assess the skin biopsy and typically 2-3 samples are required from the scalp at areas where scarring is visible.

How does a dermatologist treat Lichen planopilaris?

As this condition can result in permanent hair loss, early treatment is important. This condition can be difficult to treat and not all patients respond to treatment. The aim of treatment is to prevent progression of the hair loss rather than being able to regrow hair.

Treatments can include topical treatments such as topical steroids or topical calcineurin inhibitors or intralesional steroid injections to the affected areas. Systemic treatment can also be used such as hydroxychloroquine, the tetracycline group of antibiotics for their role as anti-inflammatory agents or sometimes other immunosuppressive medication. Treatment with systemic medication for lichen planopilaris does need close clinical monitoring as some of the medications do have side effects.